Get lean or die trying

Working in the healthcare system sometimes requires self-abnegation, we get that. And we will willingly and gladly do it all: work overtime, skip our breaks and meals, run all shift long, work to exhaustion, if that’s what it takes for the work to be done and done well. We are dedicated to our craft, and we will go the extra mile in order to deliver the care our patients require, whether it’s a bed bath, a dressing change, a clean room, a warm meal or simply lending them our ear. Yes, some contexts, some situations require self-abnegation and self-sacrifice from those of us working in the healthcare system, we do not deny nor question that.What is highly questionable, on the other hand, would be the willingness to make such situations the norm, whereas they ought to be exceptional. The massive implementation of the Toyota Management System (TMS), now better known as the Lean, or Just-In-Time model, or Kaizen, throughout Quebec’s health care system over the last few years leaves no doubt: both the government and our employers intend on intensifying and accelerating our workload for the sake of balanced budgets and at the cost of our working conditions and patient care quality.Management firms such as Proaction and Fujitsu are currently making millions of dollars helping in “leaning” several CSSS in the province. Managers, healthcare professionals, and government officials are paying hundreds to thousands of dollars to attend conferences organised or paid for by these firms, where they are taught how to minimize “waste” (read: staff and all other resources) and how to maximize productivity (the amount of work done per worker per hour) and client satisfaction. For every penny saved by the government and our employers, either we or our patients will pay for with his or her health and well-being.

Former health minister Bolduc openly acknowledged that the main goal is to do « 30% more work with the same staffing size », which is exactly what Proaction righteously claims on its website to have achieved at the CSSS Cavendish. The impact on patients‘ health and well-being is of course never really discussed, even less so the impact on our working conditions. Everything will get better, they say. And when those among us who have had the opportunity to experience a leaned working place point out that the Lean is deeply dehumanizing in addition to being dangerous, we are served unconvincing false reassurances, told that it will eventually get better, or simply to stop complaining. Yet, the deleterious effects of a Lean management approach on working conditions and quality of care cannot simply be brushed aside: increased workplace violence, drastically decreased amount of time available for direct patient care, constant pressure to work faster, increased risk of errors, increased time spent looking for basic supplies, increased rates of burnout, illness, and work-related injuries among workers etc.

Sociologist Angelo Soares has been one of the first to warn against the Toyota system in Quebec, based on his observations of “leaned” workplaces and the distress experienced by workers he witnessed. Not to mention the infamous working conditions of the Toyota factories in Japan, right where the management model was originally developed. It is also worth recalling that every year, several Japanese workers die from work exhaustion, or karoshi. The deadliness of a culture of constant overwork is no longer to be proven. Despite the sugar-coated, overly positive government’s speech, the Lean does and will ultimately make things worse, and it rests upon our shoulders to denounce, resist, and fight it.

But because these organisational models are often implemented in a subtle, gradual fashion and often times with the help of good-willed colleagues, workers tend to only fully realize the change and its effects once the reorganisation is well under way. In most cases, very little to no information at all is given to us, and the reorganisation is not even officially announced. By the time we realize that we have been leaned, we are often too tired or disillusioned to voice our protest, and we end up accepting the new way; we try and adapt to it, but at what cost!

We, workers forming the STAT committee, refuse to give up. We refuse to silently witness the degradation of our healthcare system and working conditions. In the last few months, we have worked hard at producing this modest brochure, a self-defence guide against the Lean management addressed to our fellow healthcare sector workers. Our goal is both to make the workers’ voices heard on this issue, to inform our colleagues, and to foster solidarity among us, so as to develop the collective power to defend ourselves against the merchandising of health and healthcare and its effects on us all.

This version of our brochure is in French only, and we sincerely apologize for the unilingualism. We have made every effort to find a charitable and capable French-to-English translator, all in vain. If you would be interested in helping with this, please let us know by sending us an email; we would be forever grateful.